Provider Demographics
NPI:1851761522
Name:KAIA, RELENDRA RAELLE (MS)
Entity type:Individual
Prefix:
First Name:RELENDRA
Middle Name:RAELLE
Last Name:KAIA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3735 SE 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-3036
Mailing Address - Country:US
Mailing Address - Phone:541-631-0016
Mailing Address - Fax:
Practice Address - Street 1:3735 SE 34TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-3036
Practice Address - Country:US
Practice Address - Phone:541-631-0016
Practice Address - Fax:503-765-7713
Is Sole Proprietor?:No
Enumeration Date:2015-10-06
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC5063101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health